On Tuesday, Washington will start complying with federal rules that were put into place two years ago after Congress passed a law requiring Medicaid recipients and new applicants to show proof of citizenship to get coverage.

Medicaid pays for medical bills, prescription drugs and birth-related expenses mainly for the poor and the disabled. Its costs are borne roughly 50-50 by the state and federal governments.

Since July 1, 2006, the state Department of Social and Health Services has been providing medical coverage as long as applicants declare they are U.S. citizens.

However, that declaration alone is not acceptable to federal officials. Federal officials want Medicaid recipients to show a birth certificate or other document to prove both identity and citizenship.

Doug Porter, assistant DSHS secretary for Health and Recovery Services, said Thursday that state officials were hoping Congress would change its citizenship requirement, but it’s clear that won’t happen. Gov. Chris Gregoire’s administration decided when the new rule took effect that Washington would continue Medicaid coverage or initiate new coverage to applicants while DSHS workers tried to verify citizenship. The state didn’t want to disrupt services, Porter said.

A state audit pointed out in January that DSHS was not following federal regulations and that Washington might have to pay back some of the hundreds of millions of dollars the state has gotten from the federal government.

“I’m glad we’re getting to the point where we’re complying,” said state Rep. Gary Alexander of Olympia, top Republican on the House budget committee and a member of the Caseload Forecast Council. “I’m hopeful there won’t be a significant repayment, because we don’t have the resources to pay it.”

U.S. MIGHT REQUIRE REPAYMENT

Porter made a special presentation to the council on Thursday. The council is comprised of legislators and state agency officials who try to figure out how many students will attend public schools, how many inmates will be in prison and how many people will be getting public assistance since all of those forecasts are used to write the state budget.

Porter said it will be up to federal auditors – not state auditors – to decide whether Washington has to pay back any federal funds for spending the money on noncitizens.

He said 16,283 of the 325,000 adults who are now receiving Medicaid benefits have not yet verified they are U.S. citizens. Based on the past two years’ experience, it appears about 3,100 of them never will be able to prove they are citizens and will be terminated from Medicaid, he said. The number could be higher, he added.

Over the past two years, a special unit of 27 DSHS workers has been assigned to helping Medicaid applicants verify their citizenship.

Manning Pellanda, director of that unit, said the state has checked out about 500,000 people. That included those who already were receiving benefits, as well as new applicants.

Next week, that special unit will be reduced to seven workers since it will be checking citizenship only for new applicants, he said.

ONLY ONE NONCITIZEN FOUND

During Thursday’s council meeting, Porter said those checks, which cost millions of dollars in state resources and staff time, found only one person on Medicaid who wasn’t a U.S. citizen. She was a 64-year-old British Columbia woman, he said.

However, an additional 739 applicants walked out of DSHS offices when they were asked to produce citizenship documents, and another 1,469 who signed up for Medicaid later failed to produce the necessary documents.

Porter said some of the people who signed up for cash assistance didn’t respond to requests for citizenship documents because they wanted only the benefit checks, not medical coverage.

The biggest problem to establishing citizenship is getting birth certificates for people born in other states, either because the applicants don’t have the documentation to prove who they are or because other states can’t track them down, he said.

Porter said his office will have a better estimate by December, but it appears that from now on about 1,500 people will be denied Medicaid coverage each month because they can’t immediately prove they are citizens. Eventually, 80 percent of them will track down the needed documents, he said.

“That’s the tragedy,” said Tony Lee, advocacy director for Solid Ground, a King County nonprofit that advocates for the poor. “Eventually, most of them are going to be able to prove it, but they are going to go without coverage for months and months. These people are going to be out of luck. They are not going to be able to get medical care.”

Lee said the federal citizenship requirement is another example of a law that unfairly hits unintended targets.

“It was a rule aimed at weeding out noncitizens or people who are not here legally or are not entitled to benefits,” Lee said. “But the people affected are citizens who don’t have birth certificates. It targets immigrants, but who it hits is citizens.”

Joseph Turner: 253-597-8436

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